Regression of residual tissue after incomplete resection of submucous myomas

Objective Assessment of regression of residual tissue after incomplete transcervical resection of myomas (TCRM), by transvaginal ultrasound examination with the use of saline infusion into the cavity (hysterosonographic examination; HSE). Settings A university teaching department. Subjects 45 patients with menometrorrhagia. Interventions The patients were followed up with HSE for 6 months after TCRM. The mean diameter of the myomas as assessed by preoperative HSE was 3.2 cm (range 1.5–5). According to the European Society of Gynaeological Endoscopy (ESGE) standards the myomas were classified as 11 type II, 28 type I and 6 type 0 myomas. TCRM was performed until the incision was level with the myometrium. Resection was complete in seven patients, who mainly had pedunculated tumours. Results At 2 weeks after the operation 33 of the 38 patients who had undergone incomplete resection still had residual tissue demonstrated at HSE, and all the patients had endometrial defects. During the following 2 months, re‐resection was performed in three patients because of persistent heavy bleeding. At 3 months after the operation, total regression of residual tissue was found in a further 16 patients. Thus, at 3 months, out of 35 of the patients with an initially incomplete resection, 21 patients showed spontaneous regression. Re‐resection was subsequently performed in four patients and hysterectomy in one patient. During observation for a further 3 months or more, total regression was seen in one patient. Accordingly spontaneous regression was observed in a total of 22 of 35 patients with an incomplete primary resection. Conclusions The results indicate that spontaneous regression of residual tissue left behind after incomplete resection of partially intramural submucous myomas is seen in more than half of patients with incomplete primary resection, mainly during the first 3 months.